PERIVASCULAR DEMYELINATION

Dear Doctor,

My father is 67 years old at the moment he is not able to make any body movements without help. He is not even able to chew the food properly. It all started with a fever and swelling in feet about 30 months before. He is completely bed-ridden and can not even walk on his own.

He used to walk and talk during this problem but with the passage of time (particularly during last 3 months) he is deteriorating and as on today is unable to do anything by himself. Not even chewing and he talk very very little which is also not clear.

We have been taking him to many doctors and now since last 2 years, he is on medication from a reputed Neurologist in North India. But no improvement.

We got his MRI done in August 2007, the results are mentioned below:
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Posterior fossa structures including the fourth ventricle are normal. Both the cerebeller hemispheres show normal signal intensity. No focal lesion is seen. Eight Cranial nerve complexes are seen bilaterally and are unremarkable. Brain stem is also grossly unremarkable.

There is E/O multiple, extensive, patchy ill-defined hyperintensities in the periventricular white matter bilaterally on T2 weighted and Flair images, few are more discrete represent lacunar infarcts and are S/O changes of perivascular demyelination.

Ventricular system and the various CSF spaces are prominent.

Sellar/para-sellar anatomy is normal.

No extra / intra-axial collection is seen.

Various flow void phenomena are normal.

Both orbits and optic nerves are grossly unremarkable.

IMPRESSION :
* EXTENSIVE CHANGES OF PERIVASCULAR DEMYELINATIONAND DIFFUSE CEREBRAL ATROPHY.
To be correlated clinically.
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His HB is stable for last 6 months at 9mg. He is not diabetic and did not have any blood pressure problems. But for last 15 days, his blood pressure is fluctuating (some times higher & some times lower than normal limits)

Please advise what your expert opinions and remedial measures as he is just 67 years old.

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